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2013 Medicaid School Based Services PowerPoint PPT Presentation

2013 Medicaid School Based Services. Presented by Kristen Brice Provider Field Representative. Contact Xerox. Call 505-246-0710 or 800-299-7304 - to directly reach all provider help desks including Provider Relations, Provider Enrollment, the HIPAA/EMC help desk and TPL.

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2013 Medicaid School Based Services

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Timely Filing Limits

For schools, the filing limits are 120 days for the initial filing period and 120 days for the grace period (rather than 90 days).

If you need to verify your ProviderNPI Number please follow link below.

http://www.npinumberlookup.org

Timely Filing Limits

When the recipient has retroactive eligibility, the initial filing limit is 120 days from the date the eligibility was added to the Xerox eligibility file and was therefore available to providers.

Exceptions to the filing limit

When the provider was not originally enrolled as a MAD provider on the date of service, the filing limit of 90-days is counted from the date the provider was notified of the enrollment, but must not exceed 210 days from the date of service.

A provider should submit a provider participation agreement in sufficient time to allow processing and still meet the Medicaid 210 day limit for submitting the claim.

Timely Filing Denials

Helpful Hints

There are two filing limits to meet:

The initial filing limit – 120 days from date of service

The grace period limit – 90 days from paid/denial date

Continuing to re-file a claim does not continue to extend the filing limit. So it is to the provider’s advantage to file or request an adjustment on the most recently filed claim that met the original filing limit.

When requesting an adjustment on an adjusted claim, use the TCN of the final payment or denial, not the credit record which has a negative amount on the RA.

The filing limit does not apply when the provider is returning an overpayment to the Medicaid program.

Timely Filing Denials

Re-filing Claims and Submitting Adjustments

CMS 1500 form: Put the TCN in block 22 on the paper form. Leave the “Code” blank, and put the TCN in the “Original Reference No.” field.

Claim Form Instructions

Where to get a copy of claim form instructions

Click on Provider Information

Where to get a copy of claim form instructions

Scroll down

Open file

Medicaid Claim Forms

111223333

Patient, Petunia

11 11 90

X

If a referring provider is required in order to be paid or if you simply wish to enter this information on the claim, enter the referring provider’s name in box 17 and the referring provider’s NPI in box 17b.

Doe, John

1223334444

RENDERING PROVIDER’S NPI/Taxonomy

43310

2722

QUALIFIER

25000

ZZ

273R00000X

99214

25

123

78 01

1

05 30 07

05 30 07

11

1234567890

Health care providers:

If you are a health care provider, you must submit your NPI.

The NPI goes in Box 33a.

If the NPI is not submitted, the claim will deny.

Optional

Optional

78 01

X

Provider Med Gp 505 333-4444

1234 Rocky Road

Mountain View, NM 8888

Situational

Required

1234567890

ZZ363LF0000X

Taxonomy: If you wish to submit rendering provider taxonomy code, it goes in Box 33b preceded by the qualifier “zz”.

Do not enter a space between the qualifier and the taxonomy code. An example of a correctly submitted taxonomy code is: zz103T00000X.

Enter TCN for proof of Timely Filing in box 22 (ORIGINAL REF. NO)

43310

2722

30825900085000001

25000

ZZ

273R00000X

05 30 07

05 30 07

11

99214

25

123

1

1234567890

Optional

Optional

78 01

X

Provider Med Gp 505 333-4444

1234 Rocky Road

Mountain View, NM 8888

Situational

Required

1234567890

ZZ363LF0000X

School Based Claims Reminders

Place of Service

Use place of service (POS) 03 when services are provided at school

Use POS 11 when services are provided at the office

Use POS 99 for all other sites/venues

Did you remember to?

Verify that the CPT, HCPS, Diagnosis, etc. that you are billing for:

are covered services with Xerox

are covered for the appropriate age range

are covered for the appropriate gender

do not exceed the max allowed of units per line

If invoice is required remember to attach the invoice

does have the billing and rendering provider type selected to bill/render the services

Did you remember to? Continued

Ensure the line item charges are correct and match the total charge

Procedure and diagnosis codes are entered correctly

Sign and date the claim

Taxonomy Code

For School Based billingprovider type 345, the valid Taxonomy Code is: